Analysis of our results in the treatment of Peyronie´s disease with Clostridium histolyticum collagenase and modeling using penis extender
Alonso-Isa, M1; García-Gómez, B1; Medina-Polo, J1; Justo-Quintas, J1; García-Rojo, E1; Romero-Otero, J1
1: I+D+I Men's Health Department of Urology, Hospital 12 de Octubre, Spain
Introduction and Objectives: Clostridium histolyticum collagenase (CHC) may be an important therapeutic alternative in the management of patients with Peyronie’s disease (PD) as several clinical trials have demonstrated the efficacy and safety. Our purpose was to analyze our results in the management of Peyronie’s disease with intralesional injection of CHC and modeling, both manual and using penis traction devices.
Material and Methods: We reviewed prospectively patients diagnosed with PD and managed with CHC in our centre from October 2015 to October 2017. All patients had a penis curvature of at least 30º and a palpable penile plaque. We collected demographic characteristics and erectile function was assessed using the International Index Erectile Function (IIEF-5) questionnaire. Penis curvature was measured by Kelami test. Our protocol consists of two injections of CHC administered into the penis plaque 24-72 hours apart. Manual modeling maneuvers and the penis traction device was placed for a minimum of 6 hours per day since three days after the injections. The cycle was repeated after six weeks for up to 4 cycles.
Results: We included 44 patients with a mean age of 51.7 years (25-67) with a pretreatment mean penis curvature 60º (35-90). Penis curvature was dorsal in 29 cases, lateral in 10 cases, dorsolateral in 4 cases, and ventral in 1 case. 3 patients completed 4 cycles, 8 completed 3 cycles, 18 completed 2 cycles and 15 completed 1 cycle. The mean reduction of penile curvature after the first cycle was 11.31º (18.8%) with a mean curvature after the first cycle was 48.7º (range 10-90). The mean final posttreatment reduction in curvature taking into account all the cycles was 18.6º (31.0%) with 41.4º (0-90) as mean penile curvature. Complications included hematoma in 2 patients, one urethral bleeding, one cutaneous blood blister and one penile plaque fracture. All complications were managed conservatively.
Conclusion:CHC injections and modeling in PD reduced the curvature of the penis. It is a treatment that may avoid penile surgery for PD in several cases and when necessary, the procedure may be a less invasive surgery. Complications were not frequent and they could be managed with conservative maneuvers.
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